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The pathophysiology and treatment of glaucoma: a review.

Abstract

IMPORTANCE

Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmologic examination and in more actively participating in the care of patients affected by this condition.

OBJECTIVE

To describe current evidence regarding the pathophysiology and treatment of open-angle glaucoma and angle-closure glaucoma.

EVIDENCE REVIEW

A literature search was conducted using MEDLINE, the Cochrane Library, and manuscript references for studies published in English between January 2000 and September 2013 on the topics open-angle glaucoma and angle-closure glaucoma. From the 4334 abstracts screened, 210 articles were selected that contained information on pathophysiology and treatment with relevance to primary care physicians.

FINDINGS

The glaucomas are a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression.

CONCLUSIONS AND RELEVANCE

Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination. They can improve treatment outcomes by reinforcing the importance of medication adherence and persistence and by recognizing adverse reactions from glaucoma medications and surgeries.

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  • Authors+Show Affiliations

    ,

    Hamilton Glaucoma Center, Shiley Eye Center and Department of Ophthalmology, University of California, San Diego, La Jolla.

    ,

    Singapore National Eye Center, Singapore, Singapore3Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

    Hamilton Glaucoma Center, Shiley Eye Center and Department of Ophthalmology, University of California, San Diego, La Jolla.

    Source

    JAMA 311:18 2014 May 14 pg 1901-11

    MeSH

    Glaucoma, Angle-Closure
    Glaucoma, Open-Angle
    Humans
    Primary Health Care

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    24825645

    Citation

    Weinreb, Robert N., et al. "The Pathophysiology and Treatment of Glaucoma: a Review." JAMA, vol. 311, no. 18, 2014, pp. 1901-11.
    Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;311(18):1901-11.
    Weinreb, R. N., Aung, T., & Medeiros, F. A. (2014). The pathophysiology and treatment of glaucoma: a review. JAMA, 311(18), pp. 1901-11. doi:10.1001/jama.2014.3192.
    Weinreb RN, Aung T, Medeiros FA. The Pathophysiology and Treatment of Glaucoma: a Review. JAMA. 2014 May 14;311(18):1901-11. PubMed PMID: 24825645.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The pathophysiology and treatment of glaucoma: a review. AU - Weinreb,Robert N, AU - Aung,Tin, AU - Medeiros,Felipe A, PY - 2014/5/15/entrez PY - 2014/5/16/pubmed PY - 2014/5/27/medline SP - 1901 EP - 11 JF - JAMA JO - JAMA VL - 311 IS - 18 N2 - IMPORTANCE: Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmologic examination and in more actively participating in the care of patients affected by this condition. OBJECTIVE: To describe current evidence regarding the pathophysiology and treatment of open-angle glaucoma and angle-closure glaucoma. EVIDENCE REVIEW: A literature search was conducted using MEDLINE, the Cochrane Library, and manuscript references for studies published in English between January 2000 and September 2013 on the topics open-angle glaucoma and angle-closure glaucoma. From the 4334 abstracts screened, 210 articles were selected that contained information on pathophysiology and treatment with relevance to primary care physicians. FINDINGS: The glaucomas are a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression. CONCLUSIONS AND RELEVANCE: Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination. They can improve treatment outcomes by reinforcing the importance of medication adherence and persistence and by recognizing adverse reactions from glaucoma medications and surgeries. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/24825645/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2014.3192 DB - PRIME DP - Unbound Medicine ER -